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STATE ID NUMBER 00000013097001 <br />APPLICATION FOR PERMIT TO OPERATE ))Wf7FDr Dn1(Aln CTnOAre �AAly <br />[ OWNER <br />4AME(CORPORATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />t L L DIESEL SERVICE INC ( 1 <br />01 FED ( ) 02 STATE ( ) 03 LOCAL <br />:TREET ADDRESS CITY <br />!417 WEST LANE SZIP <br />TOCKTON CAATe 95205 <br />II FACILITY <br />FACILITY NAME <br />( 1 01 TANK (X) 04 OTHER: SUMP <br />( 1 INCHES <br />CONTAINER NUMBER 1 <br />R A L DIESEL SERVICE INC <br />( ) 01 NEW PERMIT <br />( 1 02 CONDITIONAL PERMIT <br />( ) 05 RENEWED <br />( <br />PERMIT <br />( ) 07 TANK CLOSED <br />[ 7 09 DELETE FROM FILE (NO FEE) <br />J. ROKOSZEWSKI <br />) 06 AMENDED <br />PERMIT <br />( ) 08 MINOR CHANGE <br />(NO SURCHARGE) <br />[ OWNER <br />4AME(CORPORATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />t L L DIESEL SERVICE INC ( 1 <br />01 FED ( ) 02 STATE ( ) 03 LOCAL <br />:TREET ADDRESS CITY <br />!417 WEST LANE SZIP <br />TOCKTON CAATe 95205 <br />II FACILITY <br />FACILITY NAME <br />( 1 01 TANK (X) 04 OTHER: SUMP <br />( 1 INCHES <br />CONTAINER NUMBER 1 <br />R A L DIESEL SERVICE INC <br />MANUFACTURER (IF APPROPRIATE): <br />DEALER/FOREMAN/SUPERVISOR <br />I C. YEAR INSTALLED (X) UNKNOWN <br />D. <br />CONTAINER CAPACITY: GALLONS (X) UNKNOWN <br />J. ROKOSZEWSKI <br />CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br />STPEET ADDRESS <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />( ) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />(X) 05 WASTE OIL ( ) 06 OTHER <br />f ) 01 <br />( ) <br />fX) 12 <br />2417 WEST LANE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />l ) 10 NON-METALLIC <br />NEAREST CROSS STREET <br />KLINGER <br />CITY <br />STOCKTON <br />COUNTY <br />ZIP <br />SAN JOAQUIN <br />95205 <br />MAILING ADDRESS <br />CITY <br />P.O. BOX 8128 <br />STATE <br />ZIP <br />STOCKTON <br />CA <br />95208 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-466-4725 <br />( ) 01 GASOLINE STATION (X) 02 OTHER DIESEL REPAIR SHOP <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY : <br />TOWNSHIP <br />RANGE <br />SECTION <br />1 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />)AYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />ZOKOSZEWSKI, J. 209-466-4725 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />( 1 01 TANK (X) 04 OTHER: SUMP <br />( 1 INCHES <br />CONTAINER NUMBER 1 <br />S. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG= <br />I C. YEAR INSTALLED (X) UNKNOWN <br />D. <br />CONTAINER CAPACITY: GALLONS (X) UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />( ) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />(X) 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE <br />( 1 INCHES <br />( ) CM fX) UNKNOWN <br />B. <br />( 101 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 <br />NON -VAULTED <br />(X) 03 UNKNOWN <br />C. <br />f l 01 <br />DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br />0. <br />f ) 01 <br />( ) <br />fX) 12 <br />CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 <br />06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE <br />UNKNOWN ( ) 13 OTHER: <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />l ) 10 NON-METALLIC <br />HELu"u/u18S (10/18/85) <br />.w <br />PAGE 1 <br />